Comparison of endonasal dacryocystorhinostomy (DCR) versus endocanalicular diode laser DCR for the treatment of nasolacrimal duct obstruction

Abstract

Objective: Dacryocystorhinostomy (DCR), the treatment for nasolacrimal duct obstruction, is generally performed endonasally. In this retrospective study, we compared the anatomical and functional success rate of endonasal DCR with endocanalicular diode laser DCR. Methods: Medical records of 53 patients in endonasal DCR group (Group 1) and 47 in endocanalicular diode laser DCR group (Group 2) were analyzed for preoperative syringing and probing evaluations as well as surgical details, outcomes and complications. Results: Recurrence was observed in eight patients in Group 1 and six in Group 2. Although the recurrence rates differed between the two groups, this difference was not statistically significant (p>0.05). The complications in Group 1 included eight cases of synechia and one tube protrusion, whereas the complications in Group 2 included two cases of synechia, two tube protrusions and two punctum atrophies. The presence of allergy, concha hypertrophy and septum deviation did not significantly increase the rates of recurrence or complications (p>0.05). Bleeding and pain were observed significantly more frequently in Group 1 and the patient comfort was significantly better in Group 2 (p

Keywords

• Complication, dacryocystorhinostomy, diode laser, endocanalicular, endonasal

Nazolakrimal kanal obstrüksiyonunun tedavisinde endonazal dakriyosistorinostomi (DSR) ve endokanaliküler diyot lazer DSR'nin karşılaştırması

Öz

Amaç: Nazolakrimal kanal obstrüksiyonunun tedavisi olarak dakriyosistorinostomi (DSR) genellikle endonazal yoldan gerçekleştirilmektedir. Bu retrospektif çalışmada endonazal DSR ile endokanaliküler diyot lazer DSR'nin anatomik ve fonksiyonel başarı oranlarını karşılaştırdık. Yöntem: Endonazal DSR grubunda 53 (Grup 1) ve endokanaliküler diyot lazer grubunda (Grup 2) 47 hastanın tıbbi kayıtları preoperatif enjeksiyon ve prob uygulamaları, cerrahi ayrıntılar, sonuçlar ve komplikasyonların değerlendirmesi açısından incelendi. Bulgular: Grup 1'de 8 ve Grup 2'de 6 hastada nüks gözlemlendi. İki grup arasında nüks oranları farklılık göstermesine karşın bu farklılık istatistiksel açıdan anlamlı değildi (p>0.05). Grup 1'deki komplikasyonlar 8 sineşi ve 1 tüp protrüzyonu, Grup 2'de ise 2 sineşi, 2 tüp protrüzyonu ve 2 punktal atrofi olgusunu içermekteydi. Alerji, konka hipertrofisi ve septum deviasyonu nüks ve komplikasyon oranlarını anlamlı derecede artırmamıştı (p>0.05). Grup 1'de kanama ve ağrı anlamlı derecede daha sık gözlenmiş olmasına rağmen Grup 2'de hasta konforu anlamlı derecede daha iyi idi (p

Anahtar Kelimeler

• Komplikasyon, dakriyosistorinostomi, diyot lazeri, endokanaliküler, endonazal

References

1. Yang JW, Oh HN. Success rate and complications of endonasal dacryocystorhinostomy with unciformectomy. Graefes Arch Clin Exp Ophthalmol 2012;250:1509–13.
2. Preechawai P. Results of non endoscopic endonasal dacryocys- torhinostomy. Clin Ophthalmol 2012;6: 1297–301.
3. Cakmak SS, Yildirim M. Use of endocanalicular dacryocystorhi- nostomy with multidiode laser in children. Int J Pediatr Otorhinolaryngol 2010;74:1320–2.
4. Plaza G, Beteré F, Nogueira A. Transcanalicular dacryocysto rhi- nostomy with diode laser: long-term results. Ophthalmic Plast Reconstr Surg 2007;23:179–82.
5. Mirza S, Jones N. Laser-assisted dacryocystorhinostomy. In: Weber RK, Keerl R, Schaefer SD, editors. Atlas of lacrimal sur- gery. Heidelberg: Springer-Verlag: 2007. p. 73–85.
6. Piaton JM, Keller P, Limon S, Quenot S. First line endonasal dacryocystorhinostomy technique and results. Comparison between diode laser and electrocautery instrument. Study based on 422 procedures. [Article in French] J Fr Ophtalmol 2002;25: 135–45.
7. Eloy P, Leruth E, Cailliau A, Collet S, Bertrand B, Rombaux P. Pediatric endonasal endoscopic dacryocystorhinostomy. Int J Pediatr Otorhinolaryngol 2009;73:867–71.
8. Watkins LM, Janfaza P, Rubin PA. The evolution of endonasal dacryocystorhinostomy. Surv Ophthalmol 2003;48:73–84.

9. Fayet B, Racy E, Assouline M. Complications of standardized endonasal dacryocystorhinostomy with unciformectomy. Ophthalmology 2004;111:837–45.
10. Hartikainen J, Antila J, Varpula M, Puukka P, Seppä H, Grénman R. Prospective randomised comparison of endonasal endoscopic dacryocystorhionstomy and external dacryocystorhinostomy. Laryngoscope 1998;108:1861–6.
11. Boush GA, Lemke BN, Dortzbach RK. Results of endonasal laser- assisted dacryocystorhinostomy. Ophthalmology 1994;101:955–9.
12. Hausler R, Caversaccio M. Microsurgical endonasaldacryocys- torhinostomy with long-term insertion of bicanalicular silicone tubes. Arch Otolaryngol Head Neck Surg 1998;124:188–91.
13. Athanasiov PA, Prabhakaran VC, Mannor G, Woog JJ, Selva D. Transcanalicular approach to adult lacrimal duct obstruction: a review of instruments and methods. Ophthalmic Surg Lasers Imaging 2009;40:149–59.
14. Narioka J, Ohashi Y. Dacryocystography with nasolacrimal prob- ing under fluoroscopic guidance for treatment of congenital dacryocystocele. J AAPOS 2008;12:299–301.
15. MacEwen CJ, Young JDH. Epiphora during the first year of life. Eye 1991;5:596–600.
16. Petersen RA, Robb RM. The natural course of congenital obstruction of the nasolacrimal duct. J Pediatr Ophthalmol Strabismus 1998;15:246–50.
17. Paysse EA, Coats DK, Bernstein JM, Go C, De Jong AL. Management and complications of congenital dacryocele with concurrent intranasal mucocele. J AAPOS 2000;4:46–53.
18. Hurwitz JJ, Welham AN. The role of dacryocystography in the management of congenital nasolacrimal duct obstruction. Can J Ophthalmol 1975;10:346–50.
19. O’Donell BA, Adenis JP, Linberg JV, Rose GE, Suillivan TJ, Wobig JL. The failed probing. Clin Exp Ophthalmol 2001;29: 276–80.
20. Karim R, Ghabrial R, Lynch T, Tang B. A comparison of exter- nal and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction. Clin Ophthalmol 2011;5:979–89.
21. Onerci M, Orhan M, Ogretmenoglu O, Irkec M. Long-term results and reasons for failure of intranasal endoscopic dacryocys- torhinostomy. Acta Otolaryngol 2000;120:319–22.
22. Lee S, Yen MT. Laser-assisted dacryocystorhinostomy: a viable treatment option? Curr Opin Ophthalmol 2011;22:413–8.
23. Boboridis KG, Bunce C, Rose GE. Outcome of external dacry- ocystorhinostomy combined with membranectomy of a distal canalicular obstruction. Am J Ophthalmol 2005;139:1051–5.
24. Alaňón Fernández MA, Alaňón Fernández FJ, Martínez Fernández A, et al. Endonasal and endocanalicular dacryocys- torhinostomy by diode laser. Preliminary results. [Article in Spanish] Acta Otorrinolaringol Esp 2004;55:171–6.
25. Basmak H, Caklı H, Sahin A, et al. Comparison of endocanalicu- lar laser dacryocystorhinostomy with and without endonasal pro- cedures. Graefes Arch Clin Exp Ophthalmol 2011;249:737–43.
26. Wormald PJ, Kew J, Van Hasselt A. Intranasal anatomy of the nasolacrimal sac in endoscopic dacryocystorhinostomy. Otolaryngol Head Neck Surg 2000;123:307–10.
27. Unlu HH, Toprak B, Aslan A, Guler C. Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubation. Ann Otol Rhinol Laryngol 2002;111: 704–9.
28. Selig YK, Biesman BS, Rebeiz EE. Topical application of mito- mycin-C in endoscopic dacryocystorhinostomy. Am J Rhinol 2000; 14:205–7.
29. Fayet B, Racy E, Assouline M. Systematic unciformectomy for a standardized endonasaldacryocystorhinostomy. Ophthalmology 2002;109:530–6.
30. Rosen N, Barak A, Rosner M. Transcanalicular laser assisted dacryocystorhinostomy. Ophthalmic Surg Lasers 1997;28:723–6.
31. Hong-Ryul J, Je-Yeob Y, Mi-Young C. Endoscopic dacryocystorhi- nostomy: creation of a large marsupialized lacrimal sac. J Korean Med Sci 2006;21:719–23.
32. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
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35. Please cite this article as: Acar M, Gören F, Yazıcı D, Yıldırım G, San T. Comparison of endonasal dacryocystorhinostomy (DCR) versus endocanalicular
36. diode laser DCR for the treatment of nasolacrimal duct obstruction. J Med Updates 2014;4(3):87–93.